Pinched nerve in shoulder. Where to treat?

[dginoob]

Hi,

 

I am looking for a recommendation on where to go to get treated for what I believe to be a 'pinched nerve' in my shoulder. I have been in constant severe pain in my shoulder, neck, arm now for 3 days and my fingers now how pins and needles. There is no sign of it getting better so I am going to have to get it looked at. Does anyone have an idea on the best place to get this looked at?

 

Thanks

[tonray]

You should see a doctor ? Location of nearest hospital ? 

 

First Diagnosis....then treatment

[dginoob]

I'm on Sukhumvit, so Samitivej or Sukhumvit hospital would both be convenient.

[Pilotman]

I get pinched nerves occasionally due to a prolapsed disk.  A trained Thai masseur can sometimes sort it,  works for me anyway. I suggest that you go to  a good hotel spa to make sure you get the right type of massage!   Go for the older lady or man, they are usually much more sensitive to  trapped nerve issues. 

[RowdyAlpha]

And get some celebrex (over the counter) for the inflammation until you get it sorted and do more damage.

[dginoob]

I got some Arcoxia from Boots. They said it was for inflammation and also pain relief. It hasn't worked so I went back today for something stronger. They said they didn't have anything stronger

[alfieconn]

Just go to a competent orthopedic doctor who will probably need to X-ray or MRI to give you a correct diagnosis, i had something similar and went to various Physio's and a Chiropractor's all who guessed what the problem was and non getting it right,  finally had an MRI  from which a good doctor was able to give me a diagnosis.

[dginoob]

Where did you end up getting the MRI? And did you have a trapped or pinched nerve?

[kkerry]

 

35 minutes ago, dginoob said:

I got some Arcoxia from Boots. They said it was for inflammation and also pain relief. It hasn't worked so I went back today for something stronger. They said they didn't have anything stronger

 

Arcoxia is good for arthritic conditions. I was prescribed it for a RSI arm complaint and for that it worked really well, one of the fastest, most effective pain relievers I have taken.

 

In your case best to start by seeing an orthopedics specialist and take it from there.

[dginoob]

OK I think I will try Sukhumvit hospital this afternoon.

[Sheryl]

What you describe is most likely coming from the cervical spine. You need to see a spinal specialist, not just a regular ortho

 

Dr. Wicharn at BNH hospital spine center is excellent  https://www.bnhhospital.com/find-doctor/search-result/?dname=wicharn

 

 

[dginoob]

Sounds ominous!

 

Thanks for the recommendation Sheryl,

[Thaiwrath]

31 minutes ago, Sheryl said:

What you describe is most likely coming from the cervical spine. You need to see a spinal specialist, not just a regular ortho

 

Dr. Wicharn at BNH hospital spine center is excellent  https://www.bnhhospital.com/find-doctor/search-result/?dname=wicharn

 

 

I am currently getting over ACDF surgery.

I was diagnosed in the UK at 35 years of age with spondylosis. After consultation with the specialist at the time, I declined the surgery option, but he did say that later on in life I might have complications.

True to form, I had recently been getting similar symptoms (now 57 years of age) as the OP, went to see a spine specialist, who immediately sent me for an MRI scan , the results of which showed a severely herniated disc pressing into my spinal chord. Within a few weeks of the scan the symptoms were very rapidly getting worse, and the specialist had me operated on, in a Government hospital, within 8 days.

I go to physio twice a week at the hospital, have exercises to do at home, and the fusion itself seems perfect, but pains, spasms and numbness still exist, hence the continuing treatment. With my age, and the fact that I smoked for quite a few years, I realise it will be a long process to achieve full recovery, but the thought of possible paralysis over here with the condition of the disc, made me make the decision to go ahead with the surgery.

[dddave]

I consulted Dr Wicharn on Sheryl's recommendation for a pinched nerve in my leg and he was extremely helpful.  He trained in the US and is fluent in English. He is also very willing to discuss medical issues and answer questions.

[alfieconn]

7 hours ago, dginoob said:

Where did you end up getting the MRI? And did you have a trapped or pinched nerve?

In Cm, diagnosed with C-Spondylosis which is very common as we get older,  funny enough the pain went away by itself within a week of having the MRI.

[dginoob]

Hi all,

 

Thanks for all the replies. I ended up going to Sukhumvit hospital on Friday afternoon, as I had an appointment that day in Thong lor so it made sense to go to somewhere very close by. The doctor there has diagnosed an 'irritated nerve' and gave me 3 types of tablets Meloxicam, Eperisone, and Lyrica. Tablets have been of no help whatsoever and I have an appointment to go back and see the doc on Wednesday.

[Sheryl]

Again, I strongly recommend you see a spinal specialist such as I recommended before.

 

"Irritated nerve" is a meaningless diagnosis. What you need to know is to what extent the nerve is being compressed (because with numbness/tingling down the arm there is compression, not just "irritation) and from what underlying problem, and how likely it is to resolve with conservative management. And proper conservative management, while it would also involve medication, one of them Lyrica, would involve different meds than the other two.

 

You will need a spinal Xray and possibly an MRI. If you are concerned about costs, and Dr recommends MRI, you can do it  at this imaging facility rather than BNH hospital and and bring it to  Dr. Wicharn,  (actual MRI on A CD, not just the radiologist report of the film as he will make his own interpretation) this will save you ate least 5000 baht, maybe more, on the MRI cost, though of course entail more running around. Would be MRI of cervical spine without contrast.

 

http://www.mrithailand.com/

[dginoob]

Thanks Sheryl,

 

I tend to agree with you. I do have AIA medical insurance through work, but I am not sure of the extent of the coverage and if it would cover the cost of an MRI or not. Do you have any idea how much an MRI would cost at BNH?

 

Thanks again for all your advice.

 

Mark

[Thaiwrath]

1 minute ago, dginoob said:

Thanks Sheryl,

 

I tend to agree with you. I do have AIA medical insurance through work, but I am not sure of the extent of the coverage and if it would cover the cost of an MRI or not. Do you have any idea how much an MRI would cost at BNH?

 

Thanks again for all your advice.

 

Mark

I had an MRI in a specialist place near me, because the Government hospital does not have one.

The cost was 8,000 baht. Not sure how this compares with an actual hospital. 

[Sheryl]

3 minutes ago, dginoob said:

Thanks Sheryl,

 

I tend to agree with you. I do have AIA medical insurance through work, but I am not sure of the extent of the coverage and if it would cover the cost of an MRI or not. Do you have any idea how much an MRI would cost at BNH?

 

Thanks again for all your advice.

 

Mark

About 20K give or take. When I did it at the place I mentioned it was around 12K give or take but that was some years back, cal and ask them for current cost.(specify no contrast, cervical spine). You will definitely save money going that route but it does involve more running around.

 

If you want maximum savings in exchange for the most running around, see Dr Wicharn first in case he doesn't think you need more than a simple Xray, then if he recommends MRI go to the imaging center for it  and then back to see him again with the results. MRI is likely necessary but not 100% sure, sometimes a skilled doctor can tell what he needs to know from the physical exam and Xray alone.

 

If you want maximum convenience do everything at BNH.

 

BTW you can also see Dr. Wicharn at Bangkok Christian hospital but only once a week and he's there short time and inundated with patients, more frequent hours/less crowded at BNH.  Just for consultation probably not worth going to BCH it but if things start looking like surgery, it makes a meaningful difference in cost.

 

Your call.

[dginoob]

Hi Sheryl,

 

I have made an appointment online with Dr. Wicharn and I'm waiting for the confirmation. Earliest I could get was Wednesday. This is the same day as my follow up appointment at Sukhumvit hospital. I'm not sure if I should cancel that appointment or not. Also, if I do attend both of the appointments on Wednesday I'm not sure how the insurance would deal with me having 2 separate appointments at 2 different hospitals on the same day.

 

Mark

[Sheryl]

I'd cancel and see Dr. W.

 

Or you might ask if his associate Dr Eka-something is available sooner. I have not dealt with him directly myself but oither TV members give god reviews.

[dginoob]

Hi Sheryl.

 

I did find a Dr. Eakpatipan Eamskoolnont, but the earliest appointment with him is also Wednesday. My appointment with Dr. Wicharn is confirmed for Wednesday evening. 

 

Thanks again for your help and advice.

 

Mark

[dddave]

Although I was very satisfied with the treatment I received in the cadiac unit of Sukhumvit Hospital, I was very unhappy with the consultation I had there in the Orthopedic dept.  I was having very specific symptoms  and Googling them revealed a condition that corresponded with exactly with my symptoms, called Meralgia Parestetica, basically a pinched femoral cutaneous nerve. 

When I consulted with the Orthopedist at Sukhumvit and showed him the print out I brought with me, he refused to even look at it, dismissing it completely and instead suggesting a bunch of tests including a spinal MRI...a lot of money.  It just didn't make sense to me so I left.

I then took Sheryl's suggestion to see Dr. Wicharn at BNH.  He listened to my story and discussed what I thought my condition was,  He actually doubted what I had found but agreed to do a nerve function test (electrical stimulation) to rule it out. When I came in for a follow-up, he freely admitted that I had been right all along and indeed my condition was Meralgia Parestica.  He did prescribe Lyrica along with Methycobal and my symptoms started decreasing shortly thereafter and had disappeared within 2 weeks.

 

This is just further corroboration of the rule Sheryl has consistently advised:  shop the doctor and not the hospital.  

Edited August 22, 2017 by dddave

[dginoob]

Hi Dave,

 

I'm pretty sure now what I have is a cervical herniated disk - symptoms match exactly, but will wait to get confirmation from Dr. Wicharn. Nice to hear he admitted that you were right, I know some wouldn't do that.

[Thaiwrath]

3 hours ago, dginoob said:

Hi Dave,

 

I'm pretty sure now what I have is a cervical herniated disk - symptoms match exactly, but will wait to get confirmation from Dr. Wicharn. Nice to hear he admitted that you were right, I know some wouldn't do that.

That is what I partly suggested in #13, I had the same.

I am not a medical expert, however, just your symptoms had similarities to mine.

[dginoob]

Hi,

 

Just thought I would give an update. The results from my X-Ray and MRI were not good, much worse than I had thought. Even Dr. Wicharn seemed surprised. The disk between my C6 and C7 vertebrae has completely ruptured and is pressing on the spinal column. He showed me the scans of a guy who he operated on the previous evening, and my scans looked a lot worse than his. Seems the only real option is surgery to replace the disk. Price for the op is 630,000THB  , so not an option for me.

Thanks all for the input and advice. Much appreciated.

[Thaiwrath]

1 minute ago, dginoob said:

Hi,

 

Just thought I would give an update. The results from my X-Ray and MRI were not good, much worse than I had thought. Even Dr. Wicharn seemed surprised. The disk between my C6 and C7 vertebrae has completely ruptured and is pressing on the spinal column. He showed me the scans of a guy who he operated on the previous evening, and my scans looked a lot worse than his. Seems the only real option is surgery to replace the disk. Price for the op is 630,000THB  , so not an option for me.

Thanks all for the input and advice. Much appreciated.

I had exactly the same, as mentioned several times above, in fact, yours sounds like a carbon copy of mine !

I went through with the operation, but in a Government hospital, and the total cost was no more than 120,000 baht, which included the implant. I live in Issan, and see the top specialist there, but the price quoted for yours is totally obscene

[dginoob]

1 minute ago, Thaiwrath said:

I had exactly the same, as mentioned several times above, in fact, yours sounds like a carbon copy of mine !

I went through with the operation, but in a Government hospital, and the total cost was no more than 120,000 baht, which included the implant. I live in Issan, and see the top specialist there, but the price quoted for yours is totally obscene

How has it been after the operation? Completely pain free and with full mobility? 
How long did it take to recover?
Would you mind giving me the details of the specialist you saw?
I am considering going back home to have the op carried out on the NHS, but I am unsure how to arrange that.

[Sheryl]

That price must be insertion of a prosthetic disk. It is possible to instead just fuse the vertebra together after removing the damaged disk and cleaning out any bonespurs etc.

 

That would cut the price about in half.

 

Get it done at Bangkok Christian Hosp rather than BNH, further saving.  Something like 200-250K

 

If you can afford this,  you go see Dr. Wicharn again, this time at BCH and ask about this. Make clear that cost is a constraint and that you need the least expensive option.

 

If you can't afford that either you will need to get the MRI film (CD), Xray etc from BNH and have this done at a  government hospital. Go to Chulalonghorn, after hours clinic 13th floor of OPD building (have to go in person to make the appointment). You can see if Dr. Wicharn is available there but I suspect given his hours elsewhere he may not be, in that case ask for an acharn experienced in spinal surgery. Expect a lot of waits and red tape but you will eventually get it done and price then  maybe somewhere around 100-150K or so (that much due to imported titanium screws etc, they are costly).

 

Note these amounts are all just estimates on my part but for sure, fusion much less expensive than artificial disc, BCH less expensive than BNH and govt hospital less than either.

 

The only advantage to artificial disk vs fusion is that it preserves a bit more mobility but with only one level and neck, not so important